How to Get Better Access to Birth Control


In places where access to abortion is ending, contraception is more important than ever. Expanding access to contraception reduces unwanted pregnancies, which in turn reduces the need for abortion services.

Over the past 30 years, abortion rates have dropped. And more options and better access to contraceptives – including increased contraceptive coverage under the Affordable Care Act – have been identified as one of the drivers of this decline.

Even in states that score high on support for reproductive rights, gaps in contraceptive use are disturbingly common.

But contraception still remains frustrating and inaccessible to many who wish to use it. According to Power to Decide, a nonprofit organization dedicated to preventing unplanned pregnancies, 19 million women in the United States live in “contraception deserts,” where they “lack reasonable access in their county to a health center that offers the full range of contraceptive methods. “Even in states that score high on support for reproductive rights, gaps in contraceptive use are disturbingly common. In a recent study of 69,000 women in Oregon (a state A for reproductive rights), more than half had a break from birth control prescriptions at some point during a six-month period.

“Cost and financial issues — time off, co-pay, transportation — remain the biggest barriers for people getting the care they need,” according to Dr. Maria Rodriguez, professor of obstetrics and gynecology at Oregon. Health & Science University and the lead author of the study. “This is especially true in states that haven’t expanded Medicaid, or for women with high-deductible private plans.”

There are many opportunities to improve contraceptive care, and all states should seek to improve contraceptive use in the months and years to come. Here’s where to start.

1. One-Year-at-a-Time Supplies and LARC Accessible

Contraceptives should be as continuous and uninterrupted as possible to provide the best coverage against unwanted pregnancy. This requires affordable prices and convenience. Traditionally, oral contraceptives (birth control pills) and other short-term contraceptives (such as the ring or patch) are dispensed one to three months at a time, with refills for up to a year. Being able to get a year’s supply at a time eliminates the need for repeat visits to the pharmacy and has been shown to reduce the need for pregnancy tests (which can be expensive), pregnancies and health care costs. For these reasons, the Centers for Disease Control and Prevention recommends that women be prescribed a one-year supply of oral contraceptives and, more generally, that “a woman should be able to obtain COCs [combined hormonal oral contraceptives] easily in the quantity and when she needs it.

Many states have laws favoring longer-term supplies, allowing doctors to prescribe a year’s worth of contraception at a time or pharmacists to dispense a year’s supply at a time, and requiring insurance companies to cover drugs dispensed in this way. Unfortunately, “very few insurance plans actually comply with the law,” Sophia Yen, a physician and CEO of Pandia Health, a birth control delivery company, told me.

Long-acting reversible contraception (LARC) such as intrauterine contraceptives (IUC) or subcutaneous hormonal implants can be in place for five to 12 years, eliminating any gaps in coverage. In Colorado, the free LARC offer to low-income young women has been popular and has led to a marked drop in teen pregnancies and abortions. For their convenience, safety, and real-world effectiveness, LARCs should be inexpensive, widely available, and a part of any routine conversation about birth control.

2. Remove barriers to obtaining contraceptives

Online and telehealth prescribing provides convenient access to contraceptives like the pill, patch and ring. In a 2020 KFF survey, only 4% of women of childbearing age used online services to receive contraception, although this number is skyrocketing in the context of the Roe decision. “We have seen the number of daily users of our site triple since the Supreme Court ruling,” Yen said, a week after the ruling was announced.

The vast majority of people still visit a physical establishment to acquire their contraception. Allowing pharmacists to prescribe contraceptives directly to patients at the pharmacy (without requiring a physician or advanced practice provider visit for a prescription) improves access and efficiency. Data from the Rodriguez study, mentioned above, suggest that pharmacist prescribing improves continued coverage and the likelihood of staying on contraception one year after initiation. These laws are in place in only 17 states, and their implementation remains a patchwork of variables, mitigating the potential impact of this approach.

Ultimately, the accessibility offered by over-the-counter contraception is the best option.

Ultimately, the accessibility offered by over-the-counter contraception is the best option. “It’s important for people to realize that the oral contraceptive pill has a similar safety profile to over-the-counter medications, like Tylenol,” Dr. Rodriguez said. Since 2012, the American College of Obstetricians and Gynecologists (ACOG) has recommended that hormonal birth control, including pills, patches, vaginal rings, and depot injections, be available without a prescription. Earlier this month, the American Medical Association passed a policy to encourage the Food and Drug Administration to approve over-the-counter access to oral contraceptives. Allowing people to enter pharmacies and remove contraceptives from shelves without any prescription would be a major step forward in access to contraceptives.

3. Improve engagement of all healthcare professionals in education, counselling, prescribing and referrals

Contraceptive care has traditionally been left to OB-GYNs and primary care physicians. However, we are in a situation where everyone is on deck. Any contact with the health system is an opportunity to fill gaps in contraception for those who do not wish to become pregnant. A wide range of health care providers care for patients with conditions made more complex, serious, or even life-threatening by pregnancy, including diabetes, pulmonary hypertension, cardiovascular disease, and stroke. Some specialists regularly prescribe drugs that are teratogenic, that is, they carry a risk of causing birth defects, such as those that treat seizures. Because reproductive health is so intertwined with health and well-being, more providers should include in their routine practice counseling patients on contraceptives, prescribing medications, inserting contraceptive devices under and the contribution to education and orientation towards intrauterine devices and sterilization (vasectomy, tubal). ligation or removal procedures).

Unfortunately, barriers faced by patients receiving contraception include knowledge gaps among healthcare professionals and fears about prescribing, such as risks and side effects. “It is essential that all healthcare providers recognize that the risks of pregnancy always outweigh the risks of contraception,” says Dr. Rodriguez. “For (hetero)sexually active people of childbearing age, 85% will become pregnant within a year if they do not use contraception. For very effective methods, such as the IUD, there are practically no contraindications to use.

Our universal role in education as an essential component of global health is also essential. “In the coming years, the fact that more non-gynecologists are placing long-acting implants [like Nexplanon] would be helpful,” said Dr. Jane van Dis, an OB-GYN physician in New York (and my frequent collaborator). “But more importantly, we need comprehensive sex education. Contraception may be irrelevant unless people know they need to take it and understand their options.

4. Don’t forget about male contraception

Too few states recognize, at the policy level, that there are actually two parts to a pregnancy. Just as the ACA requires that any form of FDA-approved female contraception be covered with no co-pays or deductibles, all states must ensure that payers cover male contraception, including condoms and vasectomy.

Too few states recognize, at the policy level, that there are actually two parts to a pregnancy.

Innovation to increase the accessibility and speed of sterilization is also necessary; for example, there is no medically justified reason for the standard 30-day waiting period between vasectomy counseling and the procedure, something that is mandated by Medicaid programs and less often by commercial insurers. Intended to provide certainty and avoid coercion in the moment, delays and multiple visits may not respect individuals’ decision-making, create a greater burden of time and inconvenience and, because they apply primarily to low-income patients, exacerbate inequalities in contraception. “It’s yet another way for people with less means to limit their reproductive autonomy,” said Dr. Ashley Winter, a practicing urologist in Oregon.

Increased access and ease of continued and uninterrupted contraception is vital and urgent for states wishing to maintain reproductive justice and health for all of their people. In theory, even (one could say above all) states that severely restricting or prohibiting access to abortion should make contraception, the most effective means of preventing unwanted pregnancies, as simple, cheap and accessible as possible and ensure that the population of a state is knowledgeable about reproductive health and family planning.

To block abortion while totally failing to support access to contraception is to cruelly impose pregnancy, its dangers and costs, on people and their communities. In a post-Roe world, access to contraception is not something we can afford to be wrong about.


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